CN106061406B - It can delivery type surgical instruments - Google Patents
It can delivery type surgical instruments Download PDFInfo
- Publication number
- CN106061406B CN106061406B CN201580008291.1A CN201580008291A CN106061406B CN 106061406 B CN106061406 B CN 106061406B CN 201580008291 A CN201580008291 A CN 201580008291A CN 106061406 B CN106061406 B CN 106061406B
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- China
- Prior art keywords
- anvil block
- end effector
- sliding part
- shaftless
- cam
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07292—Reinforcements for staple line, e.g. pledgets
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3209—Incision instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
- A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
- A61B2017/00336—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means with a protective sleeve, e.g. retractable or slidable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/0046—Surgical instruments, devices or methods, e.g. tourniquets with a releasable handle; with handle and operating part separable
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07242—Stapler heads achieving different staple heights during the same shot, e.g. using an anvil anvil having different heights or staples of different sizes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07271—Stapler heads characterised by its cartridge
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
- A61B2017/2933—Transmission of forces to jaw members camming or guiding means
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/03—Automatic limiting or abutting means, e.g. for safety
- A61B2090/037—Automatic limiting or abutting means, e.g. for safety with a frangible part, e.g. by reduced diameter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
Abstract
In various embodiments, the invention discloses a kind of shaftless end effectors.The end effector may include anvil assembly, which includes staple forming surface.The end effector may also include staple cartridge channel, which is configured to receive nail bin wherein.The end effector may include the closed system for being configured to closed anvil.In various examples, which can also be such that the nail being contained in nail bin shapes.The end effector may also include cutting element, which is configured to the tissue that cutting is located between anvil block and nail bin.In various examples, which can be activated by closed system.In other instances, which may include the autonomous system for activating cutting element.In various examples, which can be delivered to operative site by trochar, then be operated by being assembled into one or more actuators of end effector.
Description
Background technique
This application involves surgical instruments, and in various embodiments, be related to surgical stapling and/or cutting device and
The nail bin being used therewith.
Detailed description of the invention
Refer to the following explanation of embodiment of the present invention, the features and advantages of the present invention and realization in conjunction with the accompanying drawings
The method of these feature and advantage will become more apparent, and be better understood invention itself, in which:
The cross-sectional view of the shaftless surgery system including shaftless end effector of at least one embodiment according to Fig. 1;
Fig. 2 to Fig. 6 shows the various cross-sectional views of the shaftless surgery system of Fig. 1;
Fig. 7 is the cross-sectional view of the end effector of Fig. 1 in the on-state, and end effector includes being in open position
The anvil block set;
Fig. 8 is the cross-sectional view of the end effector of Fig. 1 in closed state;
Fig. 9 is the cross-sectional view of the end effector of Fig. 1, and it illustrates the closed systems of end effector engaged with anvil block
System;
Figure 10 is cross-sectional view of the end effector of Fig. 1 under cock;
At least one is selected the shaftless end effector of embodiment else and is configured to manipulation end according to Figure 11
The cross-sectional view of the grasper of portion's actuator;
At least one is selected the shaftless end effector of embodiment else and is configured to manipulation end according to Figure 12
The cross-sectional view of the actuator of portion's actuator;
Figure 13 shows the actuator of the Figure 12 separated with the end effector of Figure 12;
At least one embodiment includes the cross-sectional view for being detachably oriented to the end effector of tie-down according to Figure 14;
Figure 15 is the detail drawing that the guiding tie-down of Figure 14 is connected to the fragile segment of end effector of Figure 14;
Figure 16 shows the detachable guiding tie-down of Figure 14 in discrete state;
The shaftless end effector including rotatable drive system of at least one alternative embodiment according to Figure 17
Cross-sectional view;
Figure 18 is the cross-sectional view of the blade members of the end effector of Figure 17;
Figure 19 is the cross-sectional view for being illustrated at the end effector of Figure 17 of cock;
Figure 20 is the view of section view end of the end effector of Figure 17;
Figure 21 is the cross-sectional view of the end effector of Figure 17, which is shown as having in fully actuated position
Figure 18 blade members;
At least one alternative embodiment includes rotatable closed system and trigger system without shaft end according to Figure 22
The cross-sectional view of portion's actuator;
Figure 23 is the cross-sectional view of the blade members of the end effector of Figure 22;
Figure 24 is the view of section view end of the end effector of Figure 22;
Figure 25 is the cross-sectional view for being illustrated at the end effector of Figure 22 of closure and complete cock;
Figure 26 is the cross-sectional view for being illustrated at the end effector of Figure 22 of fully actuated state;
Figure 27 shows the embodiment of the closure and firing lock of the integrated form for joining with shaftless end effector;
Figure 28 show be configured to the integrated form of Figure 27 be closed and firing lock be operatively engaged it is shaftless
One embodiment of end effector;
Figure 29 shows the integrated form closure and firing lock for being attached to Figure 27 of end effector of Figure 28;
Figure 30 shows the shaftless end effector of Figure 28 in closed state;
Figure 31 to Figure 32 shows the various cross-sectional views of the shaftless end effector of Figure 28;And
Figure 33 shows the end effector of Figure 28 in partial actuation state.
Specific embodiment
Present applicant also possesses the U.S. Patent application of following identification, each of these U.S. Patent applications with
Way of reference is respectively integrally incorporated herein:
The U.S. of entitled " SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS "
Patent application serial number 12/894,311 (being now U.S. Patent Publication 2012/0080496);
Entitled " SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED
STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS”
U.S. Patent Application Serial Number 12/894,340 (being now U.S. Patent Publication 2012/0080482);
The United States Patent (USP) Shen of entitled " JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS "
It please sequence number 12/894,327 (being now U.S. Patent Publication 2012/0080499);
Entitled " SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND
The U.S. Patent Application Serial Number of DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS "
12/894,351 (being now U.S. Patent Publication 2012/0080502);
Entitled " IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM
The U.S. Patent Application Serial Number 12/894,338 (being now U.S. Patent Publication 2012/0080481) of ARRANGEMENT ";
Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER "
U.S. Patent Application Serial Number 12/894,369 (being now U.S. Patent Publication 2012/0080344);
The beauty of entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS "
State's patent application serial number 12/894,312 (being now U.S. Patent Publication 2012/0080479);
The U.S. of entitled " SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE " is special
Sharp patent application serial numbers 12/894,377 (being now United States Patent (USP) 8,393,514);
Entitled " SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL
The U.S. Patent Application Serial Number 12/894,339 (being now U.S. Patent Publication 2012/0080500) of ARRANGEMENT ";
Entitled " SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING
The U.S. Patent Application Serial Number 12/894,360 (being now U.S. Patent Publication 2012/0080484) of SYSTEM ";
Entitled " SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE
The U.S. Patent Application Serial Number 12/894,322 of CARTRIDGE ARRANGEMENTS " (is now U.S. Patent Publication 2012/
0080501);
Entitled " SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES "
U.S. Patent Application Serial Number 12/894,350 (being now U.S. Patent Publication 2012/0080478);
Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE
The U.S. Patent Application Serial Number 12/894,383 (being now U.S. Patent Publication 2012/0080345) of LAYERS ";
The U.S. Patent Application Serial Number 12/894,389 of entitled " COMPRESSIBLE FASTENER CARTRIDGE "
(being now U.S. Patent Publication 2012/0080335);
The United States Patent (USP) of entitled " FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT "
Patent application serial numbers 12/894,345 (being now U.S. Patent Publication 2012/0080483);
The U.S. Patent Application Serial Number 12/894,306 of entitled " COLLAPSIBLE FASTENER CARTRIDGE "
(being now U.S. Patent Publication 2012/0080332);
Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION
The U.S. Patent Application Serial Number 12/894,318 (being now U.S. Patent Publication 2012/0080480) of MATRIX ELEMENTS ";
Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT
The U.S. Patent Application Serial Number 12/894,330 (being now U.S. Patent Publication 2012/0080503) of MATRIX ";
The U.S. Patent application sequence of entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX "
Row number 12/894,361 (being now United States Patent (USP) 8,529,600);
Entitled " FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM
The U.S. Patent Application Serial Number 12/894,367 of COMPRISING A RETENTION MATRIX " (is now U.S. Patent Publication
2012/0080485);
The beauty of entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER "
State's patent application serial number 12/894,388 (being now United States Patent (USP) 8,474,677);
Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES "
U.S. Patent Application Serial Number 12/894,376 (being now U.S. Patent Publication 2012/0080486);
Entitled " SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING
The U.S. Patent Application Serial Number 13/097,865 (being now U.S. Patent Publication 2012/0080488) of POCKETS ";
The United States Patent (USP) of entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER "
Patent application serial numbers 13/097,936 (being now U.S. Patent Publication 2012/0080339);
Entitled " STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE
The U.S. Patent Application Serial Number 13/097,954 (being now U.S. Patent Publication 2012/0080340) of PORTION ";
Entitled " STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A
The U.S. Patent Application Serial Number 13/097,856 of COMPRESSIBLE PORTION THEREOF " (is now U.S. Patent Publication
2012/0080336);
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS's "
U.S. Patent Application Serial Number 13/097,928 (being now U.S. Patent Publication 2012/0080490);
Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING
The U.S. Patent Application Serial Number 13/097,891 of AN ADJUSTABLE ANVIL " (is now U.S. Patent Publication 2012/
0080489);
The beauty of entitled " STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION "
State's patent application serial number 13/097,948 (being now U.S. Patent Publication 2012/0083836);
The U.S. Patent Application Serial Number 13/ of entitled " COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY "
097,907 (being now U.S. Patent Publication 2012/0080338);
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING
The U.S. Patent Application Serial Number 13/097,861 of DIFFERENT PROPERTIES " (is now U.S. Patent Publication 2012/
0080337);
The U.S. Patent Application Serial Number 13/097 of entitled " STAPLE CARTRIDGE LOADING ASSEMBLY ",
869 (being now U.S. Patent Publication 2012/0160721);
Entitled " COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS's "
U.S. Patent Application Serial Number 13/097,917 (being now U.S. Patent Publication 2012/0083834);
The United States Patent (USP) Shen of entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION "
It please sequence number 13/097,873 (being now U.S. Patent Publication 2012/0083833);
Entitled " STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT
The U.S. Patent Application Serial Number 13/097,938 (being now U.S. Patent Publication 2012/0080491) of COMPONENTS ";
Entitled " STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR's "
U.S. Patent Application Serial Number 13/097,924 (being now U.S. Patent Publication 2012/0083835);
The U.S. Patent Application Serial Number 13/ of entitled " SURGICAL STAPLER WITH FLOATING ANVIL "
242,029 (being now U.S. Patent Publication 2012/0080493);
The U.S. Patent application sequence of entitled " CURVED END EFFECTOR FOR A STAPLING INSTRUMENT "
Row number 13/242,066 (being now U.S. Patent Publication 2012/0080498);
The U.S. Patent Application Serial of entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK "
Number 13/242,086 (being now U.S. Patent Publication 2013/0075450);
The U.S. of entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT "
Patent application serial number 13/241,912 (being now U.S. Patent Publication 2013/0075448);
The U.S. Patent application of entitled " SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS "
Sequence number 13/241,922 (being now U.S. Patent Publication 2013/0075449);
Entitled " SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING
The U.S. Patent Application Serial Number 13/241,637 of MULTIPLE ACTUATION MOTIONS " (is now U.S. Patent Publication
2012/0074201);
Entitled " SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END
The U.S. Patent Application Serial Number 13/241,629 (being now U.S. Patent Publication 2012/0074200) of EFFECTOR ";
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF
The U.S. Patent Application Serial Number 13/433,096 (being now U.S. Patent Publication 2012/0241496) of CAPSULES ";
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS "
U.S. Patent Application Serial Number 13/433,103 (being now U.S. Patent Publication 2012/0241498);
The U.S. Patent Application Serial Number of entitled " EXPANDABLE TISSUE THICKNESS COMPENSATOR "
13/433,098 (being now U.S. Patent Publication 2012/0241491);
The United States Patent (USP) of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR "
Patent application serial numbers 13/433,102 (being now U.S. Patent Publication 2012/0241497);
Entitled " RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR's "
U.S. Patent Application Serial Number 13/433,114 (being now U.S. Patent Publication 2012/0241499);
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING ATLEAST ONE
The U.S. Patent Application Serial Number 13/433,136 (being now U.S. Patent Publication 2012/0241492) of MEDICAMENT ";
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND
The U.S. Patent Application Serial Number 13/433,141 (being now U.S. Patent Publication 2012/0241493) of EXPANSION ";
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A
The U.S. Patent Application Serial Number 13/433,144 (being now U.S. Patent Publication 2012/0241500) of RESILIENT LOAD ";
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A
The U.S. Patent Application Serial Number 13/433,148 (being now U.S. Patent Publication 2012/0241501) of RESILIENT LOAD ";
The beauty of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS "
State's patent application serial number 13/433,155 (being now U.S. Patent Publication 2012/0241502);
Entitled " METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS
The U.S. Patent Application Serial Number 13/433,163 of FOR SURGICAL STAPLERS " (is now U.S. Patent Publication 2012/
0248169);
The U.S. Patent Application Serial Number 13/433,167 of entitled " TISSUE THICKNESS COMPENSATORS "
(being now U.S. Patent Publication 2012/0241503);
The U.S. Patent Application Serial Number 13/ of entitled " LAYERED TISSUE THICKNESS COMPENSATOR "
433,175 (being now U.S. Patent Publication 2012/0253298);
Entitled " TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS "
U.S. Patent Application Serial Number 13/433,179 (being now U.S. Patent Publication 2012/0241505);
The U.S. Patent Application Serial Number 13/763,028 of entitled " ADHESIVE FILM LAMINATE " (is now the U.S.
Patent disclosure 2013/0146643);
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A
The U.S. Patent Application Serial Number 13/433,115 of LOW PRESSURE ENVIRONMENT " (is now U.S. Patent Publication 2013/
0256372);
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF
The U.S. Patent Application Serial Number 13/433,118 (being now U.S. Patent Publication 2013/0256365) of MATERIALS ";
Entitled " MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR's "
U.S. Patent Application Serial Number 13/433,135 (being now U.S. Patent Publication 2013/0256382);
Entitled " TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME's "
U.S. Patent Application Serial Number 13/433,140 (being now U.S. Patent Publication 2013/0256368);
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF
The U.S. Patent Application Serial Number 13/433,129 (being now U.S. Patent Publication 2013/0256367) of MEDICAMENTS ";
Entitled " STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED
The U.S. Patent Application Serial Number 11/216,562 (being now United States Patent (USP) 7,669,746) of STAPLE HEIGHTS ";
Entitled " SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING
The U.S. Patent Application Serial Number 11/714,049 of POCKETS OF VARYING DEPTHS " (is now U.S. Patent Publication
2007/0194082);
Entitled " SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING
The U.S. Patent Application Serial Number 11/711,979 (being now United States Patent (USP) 8,317,070) of DIFFERENT LENGTHS ";
Entitled " SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT
The U.S. Patent Application Serial Number 11/711,975 (being now U.S. Patent Publication 2007/0194079) of HEIGHT ";
Entitled " SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS
MULTIPLE WIRE DIAMETER STAPLES " U.S. Patent Application Serial Number 11/711,977 (be now United States Patent (USP) 7,
673,781);
Entitled " SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE
CAMS FOR DRIVING STAPLE DRIVERS " U.S. Patent Application Serial Number 11/712,315 (be now United States Patent (USP) 7,
500,979);
Entitled " STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED
The U.S. Patent Application Serial Number 12/038,939 (being now United States Patent (USP) 7,934,630) of STAPLE HEIGHTS ";
Entitled " SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING
The U.S. Patent Application Serial Number 13/020,263 of DIFFERENT LENGTHS " (is now U.S. Patent Publication 2011/
0147434);
Entitled " ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE
The U.S. Patent Application Serial Number 13/118,278 of FORMED STAPLES HAVING DIFFERENT LENGTHS " (is now beauty
State's patent disclosure 2011/0290851);
The beauty of entitled " ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS "
State's patent application serial number 13/369,629 (being now U.S. Patent Publication 2012/0138660);
Entitled " SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT
The U.S. Patent Application Serial Number 12/695,359 (being now United States Patent (USP) 8,464,923) of FORMED HEIGHTS ";
Entitled " STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED
The U.S. Patent Application Serial Number 13/072,923 (being now United States Patent (USP) 8,567,656) of STAPLE HEIGHTS ";
The U.S. Patent application sequence of entitled " LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR "
Row number 13/766,325 (being now U.S. Patent Publication 2013/0256380);
The beauty of entitled " ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR "
State's patent application serial number 13/763,078 (being now U.S. Patent Publication 2013/0256383);
The U.S. Patent application of entitled " LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS "
Sequence number 13/763,094 (being now U.S. Patent Publication 2013/0256377);
The U.S. of entitled " END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER "
Patent application serial number 13/763,106 (being now U.S. Patent Publication 2013/0256378);
The United States Patent (USP) Shen of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS "
It please sequence number 13/433,147 (being now U.S. Patent Publication 2013/0256369);
The beauty of entitled " SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES "
State's patent application serial number 13/763,112 (being now U.S. Patent Publication 2013/0256379);
Entitled " ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A
The U.S. Patent Application Serial Number 13/763,035 of FASTENER CARTRIDGE " (is now U.S. Patent Publication 2013/
0214030);
Entitled " RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE
The U.S. Patent Application Serial Number 13/763,042 (being now U.S. Patent Publication 2013/0221063) of HAVING THE SAME ";
Entitled " FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS
The U.S. Patent Application Serial Number 13/763,048 (being now U.S. Patent Publication 2013/0221064) of COMPENSATOR ";
Entitled " FASTENER CARTRIDGE COMPRISING A CUTTING MEMBER FOR RELEASING A
The U.S. Patent Application Serial Number 13/763,054 of TISSUE THICKNESS COMPENSATOR ";
Entitled " FASTENER CARTRIDGE COMPRISING A RELEASABLY ATTACHED TISSUE
The U.S. Patent Application Serial Number 13/763,065 of THICKNESS COMPENSATOR " (is now U.S. Patent Publication 2013/
0221065);
The U.S. Patent application of entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER "
Sequence number 13/763,021;
The beauty of entitled " ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTOR "
State's patent application serial number 13/763,078 (being now U.S. Patent Publication 2013/0256383);
The United States Patent (USP) Shen of entitled " LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES "
It please sequence number 13/763,095 (being now U.S. Patent Publication 2013/0161374);
The U.S. of entitled " IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES "
Patent application serial number 13/463,147 (being now U.S. Patent Publication 2013/0292398);
Entitled " MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING
The U.S. Patent Application Serial Number 13/763,192 (being now U.S. Patent Publication 2013/0146642) of DEVICES ";
Entitled " RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING
The U.S. Patent Application Serial Number 13/763,161 (being now U.S. Patent Publication 2013/0153641) of THE SAME ";
Entitled " ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END
The U.S. Patent Application Serial Number 13/763,177 (being now U.S. Patent Publication 2013/0146641) of EFFECTOR ";
The United States Patent (USP) of entitled " STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION "
Patent application serial numbers 13/763,037;
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH
The U.S. Patent Application Serial Number 13/433,126 (being now U.S. Patent Publication 2013/0256366) of FEATURES ";
Entitled " DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS
The U.S. Patent Application Serial Number of COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS "
13/433,132 (being now U.S. Patent Publication 2013/0256373).
Entitled " FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR
The U.S. Patent Application Serial Number 13/851,703 of INCLUDING OPENINGS THEREIN ";
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH "
U.S. Patent Application Serial Number 13/851,676;
The U.S. Patent Application Serial Number 13/851,693 of entitled " FASTENER CARTRIDGE ASSEMBLIES ";
And
Entitled " FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR
The U.S. Patent Application Serial Number 13/851,684 of AND A GAP SETTING ELEMENT ".
Certain exemplary implementation schemes will now be described, to understand the knot of apparatus and method as disclosed herein on the whole
Structure, function, the principle of manufacture and use.One or more examples of these embodiments have been shown in the accompanying drawings.This field
Those of ordinary skill will be understood that specifically describing herein and being illustrated in the device and method in attached drawing is unrestricted show
Example property embodiment, and the range of multiple embodiments of the invention is limited only by the appended claims.It is exemplary in conjunction with one
The feature that embodiment shows or describes can be combined with the feature of other embodiments.Such modifications and variations are intended to include
Within the scope of the present invention.
" multiple embodiments ", " some embodiments ", " embodiment " or " implementation that this specification refers in the whole text
Scheme " etc., it is meant that be included at least one embodiment in conjunction with the specific features of embodiment description, structure or characteristic
In.Therefore, this specification occurs in the whole text phrase " in multiple embodiments ", " in some embodiments ", " in a reality
Apply in scheme " or " in embodiments " etc. be not necessarily all referring to identical embodiment.In addition, in one or more embodiment party
In case, specific features, structure or characteristic can combine in any suitable manner.Therefore, under unconfined situation, in conjunction with one
Specific features that embodiment shows or describes, structure or characteristic can entirely or partly with other one or more embodiments
Feature, structure or characteristic combination.Such modifications and variations are intended to include within the scope of the invention.
The term as used herein " nearside " and " distal side " are to manipulate the clinician of surgical instruments as reference.Term
" nearside " refers near the part of clinician, and term " distal side " refers to the part far from clinician's positioning.Also answer
Work as understanding, for the sake of succinct and be clear, herein can in conjunction with attached drawing use space term such as " vertical ", "horizontal", "upper" and
"lower".However, surgical instruments can in many orientations and positions in use, and these terms and non-limiting and/or absolute
Change.
Various exemplary means and method are provided to execute laparoscopic type and minimally invasive surgical procedures.However, this field
Those of ordinary skill it will be readily understood that various method and apparatus disclosed herein can be used for many surgical operations and application
In, including for example combined with open surgery.With continued reference to present embodiment, those of ordinary skill in the art
Member will be further understood that, various instruments disclosed herein can in any way in insertion body, such as by natural cavity, pass through
Notch or puncturing hole for being formed in tissue etc..The working portion or end effector portion of instrument can be plugged directly into patient's body
Interior or can be inserted by the device that enters with service aisle, the end effector and elongated shaft of surgical instruments can pass through the work
Advance in channel.
Attached drawing is gone to, wherein similar number represents similar component in all several views, Fig. 1 shows shaftless outer
Section's system 2.Shaftless surgery system 2 includes trochar 4 and shaftless end effector 6.When in use, trochar 4 is passed through
One or more opening insertions in patient, such as natural aperture of one or more opening, cavity be open, operation opening and/
Or any other suitable opening.In some embodiments, trochar 4 includes endoscope and/or laparoscopic instrument.It will cover
When pipe needle 4 is introduced to operative site, end effector 6 can be located in trochar 4.In certain embodiments, by casing
Needle 4 is introduced to after operative site, and end effector 6 can be inserted into trochar 4.In some embodiments, by actuator
End effector 6 is released trochar 4 in the proximal end of lead-in bushing needle 4.In other embodiments, actuator is drawn
Enter in the distal end of trochar so that end effector 6 is drawn out trochar 4.
In various embodiments, shaftless end effector 6 includes the first jaw member 8a and the second jaw member 8b.The
One jaw member 8a includes the anvil block 10 with staple forming surface.Staple forming surface can include multiple nail shapes pits wherein.
First jaw member 8a is movably coupled to the second jaw member 8b.Second jaw member 8b includes being configured to receive nail
The vertical passage 42 in storehouse 12.Nail bin 12 includes the multiple nails 14 being disposed therein.15 quilt of pin extended from the first jaw member 8a
It receives in the slit 16 being formed on the second jaw member 8b.Pin 15 and slit 16 are configured to allow the first jaw structure
Part 8a pivots (rotation) and/or vertical movement (translation) relative to the second jaw member 8b.In various embodiments, the second pincers
Mouth component 8b can be made such as by 300&400 series, 17-4&17-7 stainless steel, titanium, and can be formed with spaced-apart sidewalls.The
One jaw member 8a can be made of such as 300&400 series, 17-4&17-7 stainless steel, titanium etc., and have nail forming following table
Face, the nail shaped lower face include multiple nail shapes pits formed therein.
Various forms of nail bins can be used together with the various embodiments of end effector 6 disclosed herein.One
In a little embodiments, implanted nail bin 12 can be used.In at least one embodiment, nail bin 12 includes main part 18, should
Main part includes compressible material (such as hemostatic material, oxidized regenerated cellulose (" ORC ") and/or bioabsorbable bubble
Foam), in the compressible material, it is supported by for example multiple rows of unfashioned metal nail 14.It is anti-in at least some embodiments
Only the alignment of the nail 14 in warehouse 18 is affected and/or prevents hemostatic material from end effector 6 is being introduced and being positioned
It is activated during in operative site, entire nail bin 12 can be coated with or be enclosed with biodegradable film, such as with trade namePolydioxanone film, polyglycerol sebacate (PGS) film of sale, by PGA (polyglycolic acid, with trade name
Vicryl is sold), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoate), PGCL (Poliglecaprone
25, with trade name Monocryl sale) and/or by the compound of PGA, PCL, PLA, and/or PDS is formed only rupture when
Just permeable biodegradable film.The main part 18 of nail bin 12 is sized to be supported on lower jaw member 8b's
In vertical passage 42, so that each nail 14 is corresponding with anvil block 10 when anvil block 10 is driven into 12 shaping contact of nail bin
Nail shapes pit alignment.In various examples, nail bin 12 can be removed from end effector 6, and in other instances, nail bin
12 can not remove from end effector 6.
When in use, 6 adjacent target tissue of end effector positions.End effector 6 is manipulated to capture destination organization
Or it is clamped between anvil block 10 and nail bin 12.Referring to Fig. 7, anvil block 10 is shown in an open position.Anvil block 10 can be towards
Tissue T is rotated downwardly in closure or clip position, as shown in Figure 8.It has been discussed in greater detail below and has been configured to make anvil
Seat 10 moves to the closed system in closed position.Nail 14 shapes in the following manner: make anvil block 10 towards nail bin 12 it is vertical or
It moves downward, while is maintained at anvil block 10 relative to nail bin 12 in parallel or at least substantially parallel orientation, to make anvil
The staple forming surface and nail shapes pit of seat 10 are contacted with nail bin 12, as shown in Figure 9.As anvil block 10 continues to move to nail bin 12
In, referring now to Figure 10, the leg for following closely 14 contacts corresponding nail shapes pit in anvil block 10, and the nail shapes pit is for making to follow closely
14 leg curvature and nail is made 14 to be configured to such as " B shape ".The further movement of anvil block 10 towards nail bin 12 will be pressed further
Contracting nail 14 simultaneously makes it be configured to desired final forming height.
In addition to above-mentioned, end effector 6 may include the closed system for being configured to closed anvil 10.Fig. 1 shows
The closed system 20 including proximal end sliding part 22a and distal end sliding part 22b is gone out.Proximal end sliding part 22a and
Distal end sliding part 22b can respectively include in a part and the second jaw member for wherein receiving the first jaw member 8a
The chamber 24 of a part of 8b.Nearside sliding part 22a includes the slipper 26a longitudinally extended from it, and distal side sliding part 22b
Including the slipper 26b longitudinally extended from it.Slipper 26a, 26b are received in a manner of it can slide to be formed in down
In longitudinal hole 28 in jaw member 8b.Fig. 2 to Fig. 6 shows each cross-sectional view of shaftless surgery system 2 shown in FIG. 1.Fig. 2 shows
The cross-sectional view of shaftless surgery system 2 is gone out, which shows trochar 4 and distal side sliding part 22b.Fig. 3 shows shaftless
The cross-sectional view of surgery system 2, the section view show distal side sliding part 22b and are limited in the distal side sliding part for connecing
Receive the chamber 24 of the distal end of the first jaw member 8a and the distal end of the second jaw member 8b.Fig. 4 shows shaftless surgery
The cross-sectional view of system 2, the section view show the first jaw member 8a including recessed portion, which is configured to connect
A part of distal side sliding part 22b is received, as described in greater detail below.In some embodiments, recessed portion includes multiple guarantors
It holds and/or depth measuring features 38, this feature also will be described in greater detail below.The slipper 26b of distal side sliding part 22b
It further shows, and is located in the longitudinal hole 28 being defined in the second jaw member 8b in Fig. 4.Fig. 5 shows shaftless
The cross-sectional view of surgery system 2, the section view show the first jaw member 8a and the second jaw member 8b, first jaw member
And second jaw member be at position between nearside sliding part 22a and distal side sliding part 22b.Fig. 6 shows shaftless
The cross-sectional view of surgery system 2, the section view show the connection pin 15 of the first jaw member 8a and the second jaw member 8b and narrow
Slot 16.Fig. 6 also shows nearside sliding part 22a and nearside slipper 26a.Side of the nearside slipper 26a can slide
Formula is received in the longitudinal hole 28 being defined in the second jaw 8b.In various examples, slipper 26a and/or sliding part
Divide 26b that can push the first jaw 8a towards the second jaw 8b as described above so that nail support the second jaw 8b when deforming.
Fig. 7 shows the end effector 6 in deployed position (that is, position of patient's body).As described above, end is held
Row device 6 can be disposed from trochar 4, for example, by by push rod be inserted into trochar 4 in so as to by shaftless end effector 6 release casing
Needle 4.When disposing from trochar 4, the first jaw member 8a and the second jaw member 8b can be at open position and/or can
It is manipulated in an open position.In at least one embodiment, anvil block 10 is by anvil block spring (not shown) and/or another kind
Bias arragement construction is biased into open position.First jaw member 8a and the second jaw member 8b are biased into opening by anvil block spring
Position, so that shaftless end effector 6 is in open position shown in Fig. 7 when disposing shaftless end effector 6 from trochar 4
It sets.
Fig. 7 to Figure 10 shows tissue clamping and nail forming process.In Fig. 7, destination organization " T " be located in anvil block 10 with
Between nail bin 12.Anvil block 10 is pivoted to initial clamping shown in Fig. 8 or partial closed position relative to lower jaw member 8b.One
In a little embodiments, can grasper and/or another instrument be passed through trochar 4 and/or pass through another trochar and be inserted into, with for example
Nearly slide 22a and distal side sliding part 22b are pushed towards each other, i.e., towards for making anvil block 10 be transformed into part closure position
The center for the end effector 6 set pushes.In various examples, nearside sliding part 22a is configured to the first pincers of contact
First jaw 8a is simultaneously moved to partial closed position from its open position by mouth 8a.Once the first jaw 8a arrived part closure
Position, distal side sliding part 22b can be moved into be contacted with the first jaw 8a.Then, can by sliding part 22a and 22b simultaneously and/or
Successively push towards each other so as to anvil block 10 is pressed on destination organization " T " and by destination organization " T " be clamped in anvil block 10 with
Between nail bin 12.Fig. 9 shows initial nail forming, and wherein anvil block 10 is just contacted with nail bin 12.Figure 10 is shown at the beginning of it
The nail 14 of beginning shaping position.
In addition to above-mentioned, end sliding part 22a, 22b can also be limited respectively for receiving the first jaw member wherein
The chamber 24 of 8a and the second jaw member 8b.The inner surface of chamber 24 being limited in each end sliding part 22a, 22b may include convex
Wheel surface, such as cam face 30.In various examples, each cam face 30 may include such as inclined surface.In certain realities
In example, inclined surface is configured to the inclined surface on the first jaw 8a of engagement.For example, the proximal end of the first jaw 8a
Portion may include driven surfaces 32, should be from when proximal end sliding part 22a is moved toward the far side towards distal end sliding part 22b
Dynamic surface can be engaged by the cam face 30 being limited on proximal end sliding part 22a.Similarly, the distal end portion of the first jaw 8a
Portion may include driven surfaces 32, should be from when distal end sliding part 22b is moved toward the far side towards distal end sliding part 22a
Dynamic surface can be engaged by the cam face 30 being limited on distal end sliding part 22b.In various examples, cam face 30
Angle can match the angle of driven surfaces 32, and in other instances, the angle of cam face 30 may differ from driven surfaces 32
Angle.In some instances, one group of surface 30,32, such as proximal face group can be limited by the first matching angle, and another
One group of surface 30,32, such as distal surface group can be limited by the second matching angle for being different from the first matching angle.Various
In embodiment, the configuration of cam face 30 and driven surfaces 32 may be selected to allow anvil block 10 to keep at least relative to nail bin 12
Substantially parallel orientation so as to simultaneously make it is all nail 14 forming.
In some embodiments, end effector 6 may include be configured to instruction nail forming height at least
One gauge.In various examples, the proximal end of end effector 6 may include forming height gauge 31 and/or end
The distal end of actuator 6 may include such as forming height gauge 31.In some instances, proximal end sliding part 22a and/or
Distal end sliding part 22b includes the gauge for being configured to the forming height of instruction nail 14.In various examples, amount
Rule may include the line of demarcation series being limited in the distal end of the second jaw 8a or array, and in addition, further include from distal side
The gauge that end sliding part 22b extends.In at least one such embodiment, gauge may include arm 34, the arm
Including head 36, and linear array of demarcating may include multiple teeth 38, and wherein head 36 can relative to the position of tooth 38
Indicate the distance that anvil block 10 has pushed down on.Similarly, gauge may include point being limited in the proximal end of the second jaw 8a
Boundary line series or array, and the gauge that proximally sliding part 22a in end extends.It is also similar to the above, gauge member
Part may include arm 34, which includes head 36, and linear array of demarcating may include multiple teeth 38, wherein head 36 relative to
The position of tooth 38 can indicate the distance that anvil block 10 has pushed down on.Referring again to Fig. 9, anvil block 10 is fixed against nail bin 12
Position, and in such position, the head 36 for the gauge that proximally sliding part 22a in end extends has slided into tooth 38
Above outermost tooth 38 in nearside array, and the head 36 of the gauge from distal end sliding part 22b extension
It has slided into above the outermost tooth 38 in 38 distal side array of tooth.Array of the gauge head 36 relative to tooth 38
This relative positioning can indicate that nail 14 not yet be deformed by anvil block 10 to clinician.It is inwardly transported in proximal end sliding part 22a
When dynamic, proximal end sliding part 22a can drive downwards the proximal end of the first jaw 8a, and head extending therefrom 36 can be slided
It moves to one or adds above tooth 38 more.Similarly, when distal end sliding part 22b is inwardly moved, distal end is sliding
Moving part 22b can drive downwards the distal end of the first jaw 8a, and head extending therefrom 36 is slid into one or more
Above additional tooth 38.When head 36 has slided into above whole teeth 38, as shown in Figure 10, clinician be may be assumed that
Nail 14 has been fully formed.
Various embodiments as described herein use compressible nail bin 12, which is supported on nail substantially
The position of upper fixation with the formation of anvil block 10 for contacting.In various embodiments, anvil block 10 is driven to unshaped nail 14
In, wherein the degree of nail forming obtained depends on anvil block 10 and is driven in nail at least one such embodiment
How far.Such arrangement allows a surgeon to adjust the amount of the forming or percussion pressure that are applied to nail, to change nail
Final forming height.
In addition to above-mentioned, the gauge extended from end sliding part 22a and 22b may include holding member, the holding
Component is configured to that end sliding part 22a and 22b are held and/or locked in place.In various examples, amount
The head 36 and/or tooth 38 for advising element may include locking shoulder, which is configured on the one hand allow to hold
Portion sliding part 22a and 22b are inwardly moved and are on the other hand resisted moving out for end sliding part 22a and 22b.In various realities
It applies in scheme, gauge may include ratchet system, which allows the movement on a direction but forbid in opposite direction
Movement.In order to overcome the locking effect of gauge, the head 36 of gauge can be raised and/or deflect away from tooth 38
Array.Once gauge is disengaged with the first jaw 8a, end sliding part 22a, 22b can be moved out to permit
Perhaps the first jaw 8a is opened.As described above, the first jaw 8a can pass through spring movement to its open position and/or energy
It is enough pulled open by grasper, the grasper such as grasper 154 (Figure 11).
Previous end effector extends from the axis of surgical instruments, and which use extend through the one or more of axis to drive
Dynamic component carrys out operation end actuator.Such as it will be appreciate that, end effector 6 is not attached to the axis of surgical instruments, and therefore
It is shaftless.In various examples, as discussed above, such as grasper can be used inwardly to push the end of end effector 6
Sliding part 22a, 22b.Grasper is configured to one at a time or simultaneously move end sliding part 22a, 22b.?
In various examples, close mechanism, such as grasper (not shown) are connected to shaftless closed system 20.In some instances, promptly
Device is opened, and shaftless end effector 6 is positioned between two arms of grasper.Grasper is transformed into from open position
Closed position, so that nearside sliding part 22a and distal side sliding part 22b is slided towards the midpoint of shaftless end effector 6.Nearside is sliding
The cam face 30 of moving part 22a and distal side sliding part 22b join with the driven surfaces 32 being limited on anvil block 10, to make anvil block
10 compress towards nail bin 12.As discussed above, 10 compressible destination organization " T " of anvil block and nail 14 is deployed to destination organization " T "
In.Once nail 14 is formed and is fastened to destination organization " T ", in addition to above-mentioned, the also openable grasper of surgeon simultaneously will
It is removed from operative site.Anvil block 10 is then openable to discharge the destination organization " T " sutured, and end effector 6 can
It is removed from operative site.Such as it will be appreciate that, it can be maintained at below or be implanted by the nail main body 18 that nail 14 is crushed and fixes.It is surplus
Remaining " broken " nail main body 18 may act as the compensating part of hemostatic material, staple line reinforcement, and/or tissue thickness's variation.Such as this
Used in text, it is meant that in addition to nail 14, at least part of the staple cartridge body 18 fixed by nail 14 also will remain in term " implanted "
Patient's body.Implanted warehouse 18 may or may not finally be absorbed by patient body.Although being described herein by reference to implanted nail bin
Various embodiments, but those skilled in the art will recognize that, it is possible to use non-built-in mode storehouse, that is, nail bin is after firing
Remain positioned in the storehouse in shaftless end effector.In various examples, nail driving is can be used in such surgical stapling arrangement
Element, the nail driving element can promote nail towards anvil block.
Although shaftless end effector 6 is shown as including nearside sliding part 22a and distal side sliding part 22b, reader will
It recognizes, nearside sliding part 22a and/or distal side sliding part 22b can be omitted.In some embodiments, it is following closely formed or is hitting
After being dealt into destination organization, shaftless end effector 6 for example can be discharged by actuating relieving mechanism.Relieving mechanism is releasable
Nearside sliding part 22a and/or distal side sliding part 22b, to keep anvil block 10 in an open position.
In certain embodiments, shaftless end effector 6 can be used only as tissue apposition device.However, in various implementations
In scheme, shaftless end effector 6 includes cutting element 40.Cutting element 40 is configured to along the vertical of end effector 6
Destination organization " T " is cut to axis.In some embodiments, cutting element 40 includes fixed blade.In at least one implementation
In scheme, lower jaw member 8b includes the cutting element 40 sharpened, which is configured to and is formed in anvil block 10
On mating component handover.When compressing anvil block 10 towards nail bin 12, anvil block 10 pushes tissue T against cutting element 40, should
Cutting element is then cut out destination organization T.In other embodiments, cutting element may include slidably cutting element, this can
Sliding cutting element can be deployed to from the unactuated position adjacent with the proximal end of shaftless end effector 6 for example with distal side
The adjacent actuated position in end.In at least one such example, cutting element is configured to slidably
Extend through the slit being centrally located in the slit and nail bin 12 in anvil block 10.Slidably cutting element can be for example by hereafter
The rotatable shaft that is more fully described is disposed.In some embodiments, slidably cutting element includes for disposing nail 14
Sliding part.
Figure 11 shows the embodiment of shaftless end effector 106.Shaftless end effector 106 is similar to Fig. 1 to figure
Shaftless end effector 6 shown in 10.Shaftless end effector 106 includes the first jaw member 108a and the second jaw member
108b.First jaw member 108a is included therein the anvil block 110 with multiple nail shapes pits.Second jaw member 108b packet
Channel 142 is included, which is configured to receive nail bin, such as implanted nail bin.Shaftless closed system 120 is adapted to
So that end effector 106 is transformed into closed position from open position and disposes the nail for the nail bin being located in channel 142.It is shaftless
Closed system includes nearside sliding part 122a and distal side sliding part 122b.Nearside sliding part 122a and distal side sliding part 122b are by structure
It causes slidably join with the first jaw member 108a and the second jaw member 108b, anvil block 110 is driven
It moves into and is contacted with nail bin and shape nail in nail bin.Nearside sliding part 122a includes inclined grip portion, the grip portion
It is upwardly extended in the side of the longitudinal axis transverse to end effector 106.In various examples, inclined grip portion may include
Slip tip 150.Slip tip 150 is configured to promote end effector 106 relative to some tissue insertion or insert
Enter in some beneath tissue.Slip tip 150 includes the promptly segment 152 for being configured to join with grasper 154.Promptly
Device 154 may include any suitable grasper, such as be adapted to be enough in the grasp device for being inserted through trochar 4.It is sliding
Dynamic tip 150 can promote shaftless end effector 106 and be placed below such as blood vessel or destination organization.In some embodiments
In, after shaftless end effector 106 is located in below destination organization, shaftless end is executed using grasper 154
The open position shown in Figure 11 of device 106 is transformed into partial closed position.Grasper 154 and/or additional mechanical actuator with
Shaftless closed system 120 joins, by being pushed sliding part 122a and 122b towards each other by shaftless end effector 106
Firing position is transformed into from partial closed position.It is sliding although slip tip 150 is shown coupled to nearside sliding part 122a
Dynamic tip 150 can extend from distal side sliding part 122b.
Figure 12 to Figure 13 shows an embodiment of shaftless end effector 206.Shaftless end effector 206 includes
First jaw member 208a and the second jaw member 208b.First jaw member 208a is included therein recessed with the forming of multiple nails
The anvil block 210 in hole.Second jaw member 208b includes vertical passage 242, which is configured to receive nail bin, all
Such as implanted nail bin.First jaw member 208a and the second jaw member 208b is coupled by pin 215 and slit 216.Pin 215 is permitted
Perhaps pivot and vertical movement of the anvil block 210 relative to the second jaw member 208b.Shaftless closed system 220 is configured to make
Shaftless end effector 206 is transformed into closed position from open position.Shaftless closed system includes nearside sliding part 222a and remote
Slide 222b.Nearside sliding part 222a and distal side sliding part 222b respectively include be formed thereon, be configured to
It is formed in the cam of the inclined-plane handover on anvil block 210.The cam of nearside sliding part 222a and distal side sliding part 222b and the first pincers
Interface between the inclined-plane of mouthful 208a can drive anvil block 210 at contact with nail bin and clamp anvil block 210 relative to second
Mouth component 208b keeps substantially parallel configuration.Nearside sliding part 222a may include being configured to fasten detachable guiding
Tie member 256 is connected to the coupling mechanism 258 of shaftless end effector 206.In some embodiments, guiding tie-down 256 wraps
Include clinoplain 260.Clinoplain 260 is at an angle of relative to the fore-and-aft plane of the second jaw member 208b to be extended.Clinoplain
260 may include such as slip tip.Guiding tie-down 256 can be positioned shaftless end effector 206 by surgeon's manipulation
At treatment site.For example, in one embodiment, the detachable tie-down 256 that is oriented to is extended proximally across trochar simultaneously
Extension is pierced by patient, and can be pulled by surgeon to position shaftless end effector 206.Once shaftless end effector
206 are positioned, and guiding tie-down 256 can be separated with shaftless end effector 206, as shown in figure 13.Although guiding is fastened
Part 256 is shown as being attached to nearside sliding part 222a, but readers will recognize that, connection can be formed on the sliding part 222b of distal side
Mechanism 258 and can will guiding tie-down 256 be connected to distal side sliding part 222b.Under any circumstance, it is oriented to tie-down 256 all
It can be used as actuator by inwardly pushing sliding part 222a and/or sliding part 222b that anvil block 210 is rotated to part closure
Position.
Figure 14 shows the embodiment of the shaftless end effector 306 including tearable guiding tie-down 356.Without shaft end
Portion's actuator 306 includes the first jaw member 308a and the second jaw member 308b.First jaw member 308a is included therein
Anvil block 310 with multiple nail shapes pits.Second jaw member 308b includes vertical passage 342, which is constructed
At nail bin, such as implanted nail bin can be received.First jaw member 308a and the second jaw member 308b passes through pin 315 and narrow
Slot 316 couples.Pin 315 allows pivot and vertical movement of the anvil block 310 relative to the second jaw member 308b.Shaftless closed system
320 are configured to that shaftless end effector 306 is made to be transformed into closed position from open position.Shaftless closed system includes close
Slide 322a and distal side sliding part 322b.Nearside sliding part 322a and distal side sliding part 322b respectively includes being formed thereon
And it is configured to and is formed in the cam of the handover of the inclined-plane on anvil block 310.Nearside sliding part 322a and distal side sliding part
Interface between the cam of 322b and the inclined-plane on anvil block 310 can drive anvil block 310 at contacting with nail bin and make anvil block simultaneously
310 keep substantially parallel configuration relative to the second jaw member 308b.Nearside sliding part 322a passes through tearable segment 358
It is connected to guiding tie-down 356.Guiding tie-down 356 can be extended proximally across trochar 4 and can be manipulated by surgeon
Shaftless end effector 306 is located in target site.After it located shaftless end effector 306, it is oriented to tie-down
356 can be discharged by tearing tearable segment 358 from shaftless end effector 306.Figure 15, which is shown, is connected to shaftless end
The tearable segment 358 of the guiding tie-down 356 of actuator 306.Figure 16 is shown in tie-down 356 and shaftless end effector
306 separate after tearable segment 358.
Figure 17 shows the embodiments for the shaftless end effector 406 for including drive system 420.Shaftless end effector
406 include the first jaw member 408a and the second jaw member 408b.First jaw member 408a be included therein be formed with it is more
The anvil block 410 of a nail shapes pit.Second jaw member 408b includes the longitudinal direction being configured to wherein receiving nail bin 412
Channel 442.Nail bin 412 includes multiple nails 14.First jaw member 408a and the second jaw member 408b are pivotally coupled.Connection
Pin 415 to the first jaw member 408a is slidably maintained at the slit being formed in the second jaw member 408b
In 416.Pin 415 and slit 416 allow anvil block 410 to pivot relative to the second jaw member 408b and towards the second jaw members
408b vertical movement.
Rotatable shaft 464 extends longitudinally through the second jaw member 408b.Rotatable shaft 464 is close with drive system 420
Slide 422a and distal side sliding part 422b are operatively engaged.Nearside sliding part 422a and distal side sliding part 422b can be respective
Including cam 430.One of cam 430 and/or the two are configured to engagement anvil block 410, anvil block 410 are rotated to and is closed
Coincidence is set, and translates anvil block 410 downwards towards storehouse 412.Axis 464 includes that the nearside that proximally sliding part 422a extends drives end
466.In various examples, rotatable input unit, such as rotating mechanism 468, such as nearside driving end 466 can be connected to rotate
Rotatable shaft 464.Axis 464 may also include the first threaded portion 465a, the second threaded portion 465b and third threaded portion 465c.
First threaded portion 465a can be threadably engaged with the threaded longitudinal hole being limited in nearside sliding part 422a.When first
On direction when rotary shaft 464, the first threaded portion 465a can be such that nearside sliding part 422a is displaced towards distal side sliding part 422b.
Second threaded portion 465b can be threadably engaged with the threaded longitudinal hole being limited in the sliding part 422b of distal side.When in first party
When upward rotary shaft 464, the second threaded portion 465b can be such that distal side sliding part 422b is displaced towards nearside sliding part 422a.For
The such relative motion of realization, in various embodiments, for example, the first threaded portion 465a may include right-handed thread, and
Two threaded portion 465b may include left hand thread.When nearside sliding part 422a and distal side sliding part 422b are moved towards each other,
Anvil block 410 can be rotated to closed position and push down on anvil block by one of sliding part 422a and 422b and/or the two
410 with broken nail 14.
Figure 17,19 and 21 show the operation that shaftless end effector 406 is converted into cock from opening state.Such as figure
Shown in 17, when anvil block 410 is in an open position, destination organization " T " is located between anvil block 410 and nail bin 412.By making anvil
Seat 410 pivots that shaftless end effector 406 is made to be transformed into partial closed position relative to the second jaw member 408b.Some
It, can be for example by applying force to pivotal anvil 410 to anvil block 410 with the grasper being inserted into across trochar 4 in example.At other
In example, anvil block 410 can move at least partly closed position by nearside sliding part 422a.Under any circumstance, rotatable
Axis 464, which is rotated into, keeps nearside sliding part 422a and distal side sliding part 422b vertical towards the central point of shaftless end effector 406
To movement.Axis 464 is rotatable until anvil block 410 is compressed storehouse 412 simultaneously by nearside sliding part 422a and distal side sliding part 422b completely
Shaftless end effector 406 is constructed in firing position, as shown in figure 19.In other cases, axis 464 may rotate to partly
It presses storehouse 412 and shapes nail 14 partly.In various examples, nearside sliding part 422a and distal side sliding part 422b can be same
When or different time contact the first jaw 408a.In at least one example, nearside sliding part 422a can be in distal side sliding part
422b contacts the first jaw 408a before contacting the first jaw 408a.
Referring again to Figure 17, end effector 406 may also include cutting element, such as cutting element 440.It is executed in end
In the open state, as shown in figure 17, cutting element 440 can be positioned on the non-progressive position of nearside to device 406.As shown in figure 18,
Cutting element 440 may include threaded longitudinal hole 470 defined therein, and axis 464 can extend across longitudinal hole 470.It is cutting
The non-progressive position of nearside of component 440 is cut, threaded hole 470 can not be threadably engaged with axis 464.More specifically, axis 464 can wrap
The unthreaded sections 467 extended between the first threaded portion 465a and third threaded portion 465c are included, and work as cutting element
When 440 progressive position non-in its nearside, the unthreaded sections 467 of axis 464 can be located in threaded hole 470.In such feelings
Under shape, when rotary shaft 464, axis 464 can not directly be such that cutting element 440 moves;However, cutting structure referring to Figure 17 and Figure 19
Part 440 can be at least initially distally advanced by nearside sliding part 422a court.In other words, make nearside in rotation by axis 464
When sliding part 422a is inwardly moved, nearside sliding part 422a can push cutting element 440 towards storehouse 412.In various examples, closely
Slide 422a can make cutting element 440 move to stage front position, that is, cutting element 440 i.e. will be crosscutting but not yet crosscutting
The position of the tissue T captured between storehouse 412 and/or storehouse 412 and anvil block 410.In various examples, in nearside as shown in figure 19
When sliding part 422a arrived its closed position, nearside sliding part 422a can make cutting element 440 move to its stage front position.
In other instances, before nearside sliding part 422a arrived its closed position, nearside sliding part 422a can make cutting element
440 move to its stage front position.In any of the above, when cutting element 440 arrived its stage front position, cut
Cutting component 440 can become to be operatively engaged with axis 464.It is cut more specifically, nearside sliding part 422a can be pushed towards distal side
Component 440 becomes to be threadably engaged with screw position 465c until the threaded hole 470 being limited in cutting element 440.Once
Cutting element 440 is threadably engaged with axis 464, and the further rotating in a first direction of axis 464 can make to cut structure
Part 440 is towards being distally advanced, as shown in figure 21.
As described above, the first threaded portion 465a can make nearside sliding part 422a advance from its unactuated position (Figure 17)
To its fully actuated position (Figure 19).When axis 464 rotates, nearside sliding part 422a will be along the length of the first threaded portion 465a
Advance.Once nearside sliding part 422a has been moved to its fully actuated position, nearside sliding part 422a can no longer be connect with axis 464
Merge and the further rotating in a first direction of axis 464 can no longer make nearside sliding part 422a advance.In other words, the first screw thread
Part 465a can nearly slide 422a be pushed to the first threaded portion 465a no longer be limited in nearside sliding part 422a
The point that is threadably engaged of threaded hole, and at such point, the unthreaded sections 467 of axis 464 be can be positioned in threaded hole.
Similarly, the second threaded portion 465b can make distal side sliding part 422b proceed to its cause completely from its unactuated position (Figure 17)
Dynamic position (Figure 19).When axis 464 rotates, distal side sliding part 422b will advance along the length of the second threaded portion 465b.Once
Distal side sliding part 422b has been moved to its fully actuated position, and distal side sliding part 422b can no longer be engaged with axis 464 and axis
464 in a first direction further rotate can no longer make distal side sliding part 422b advance.In other words, the second threaded portion 465b
Distal side sliding part 422b can be pushed to the second threaded portion 465b no longer with the threaded hole that is limited in the sliding part 422b of distal side
The point being threadably engaged, and at such point, the unthreaded sections 467 of axis 464 can be positioned on 470 in threaded hole.Each
In kind of example, nearside sliding part 422a can or at least substantially in distal side, sliding part 422b becomes and the second threaded portion 465b
Become to be disengaged with the first threaded portion 465a while being disengaged.In some instances, nearside sliding part 422a can be
Distal side sliding part 422b becomes to become before or after being disengaged with the second threaded portion 465b and the first threaded portion 465a
It is disengaged.In various examples, nearside sliding part 422a can or at least substantially become and third spiral shell in cutting element 440
Line part 465c becomes to be disengaged with the first threaded portion 465a while engagement.In other instances, nearside sliding part
422a can become and the first threaded portion 465a before or after cutting element 440 becomes and engages with third threaded portion 465c
It is disengaged.
It has fully been advanced to by axis 464 after incision tissue T and/or incision storehouse 412 in blade 440, it can be by the
Two or opposite direction on rotary shaft 464 come make blade 440 bounce back.In such example, blade 440 can be along third threaded portion
465c reversion returns to its stage front position until blade, at this stage front position, and blade is no longer logical with third threaded portion 465c
It crosses and is threadedly engaged.Similarly, the rotation of axis 464 in a second direction can be such that nearside sliding part 422a and distal side sliding part 422b returns
To its unactuated position and anvil block 410 is allowed to reopen.In some instances, when cutting element 440 just bounces back, cutting
Component 440 can contact nearside sliding part 422a so that nearly slide 422a is pushed back onto the first threaded portion 465a.Each
In kind example, end effector 406 may also include screw member, which is configured to ride upon on axis 464 simultaneously
Distal side sliding part 422b is pushed back onto the second threaded portion 465b.Under any circumstance, the threaded portion of axis 464 can have phase
Same screw pitch.In such example, the part of end effector 406 shifted by axis 464 can be moved with identical speed.At it
In his example, one or more threaded portions of axis 464 can have different screw pitch, wherein therefore, end effector 406
One or more components can move at different rates for the given rotation speed of axis 464.
Such as it will be appreciate that, end effector 406 may include single rotation driving input unit, single rotation driving input
Portion can in the first stage closed anvil 410, second stage make nail 14 deformation, and the phase III make blade 440 advance.?
In certain examples, one or more of these stages can be recurred.In at least one example, one in these stages
Or it multiple does not overlap one another.In various examples, one or more of these stages can occur simultaneously.In at least one reality
In example, one or more of these stages can be at least partly be overlapped with other one or more stages.In some instances,
Shaping stage may be needed to follow closely at least partly to occur before the cutting stage.In other instances, it may be necessary to nail forming rank
Section is completed before the cutting stage starts.Tissue T is cut before quilting in order to prevent, it may be necessary to such embodiment.
As described in greater detail below, certain embodiments may include two or more drive systems with each behaviour of actuation end actuator
Make the stage.
Figure 22 shows the embodiment party of the shaftless end effector 506 including shaftless close mechanism and shaftless firing lock
Case.Shaftless end effector 506 includes the first jaw member 508a and the second jaw member 508b.First jaw member 508a packet
Anvil block 510 is included, it is wherein including the staple forming surface of multiple nail shapes pits which, which has,.Second jaw member 508b includes
It is configured in the vertical passage 542 for wherein receiving nail bin 512.First jaw member 508a and the second jaw member 508b
It is pivotally coupled.First jaw member 508a includes pin 515, which is connected to the slit being formed in lower jaw member 508b
516.Pin 515 allow the first jaw member 508a relative to the second jaw member 508b pivotally and vertical ground motion.
Rotatable shaft 564 extends longitudinally through lower jaw member 508b.Rotatable shaft 564 is connected to close mechanism 520
Nearside sliding part 522a and distal side sliding part 522b.Nearside sliding part 522a and distal side sliding part 522b can respectively include cam
530.Each cam 530 includes the angle for being configured to and being formed in one or more skewed surfaces handover on the first jaw 8a
Degree.Rotatable shaft 564 includes driving end 566, which could attach to rotatable driving input unit, and such as rotatable driving is defeated
Enter portion 568.With it is like above, rotatable 568 rotatable shaft 564 of driving input unit, the axis can then make nearside sliding part 522a
With distal side sliding part 522b towards the central point longitudinal movement of shaftless end effector 506.Nearside sliding part 522a and distal side are sliding
The longitudinal movement of moving part 522b towards the central point of shaftless end effector 506 contact cam 530 with the first jaw 8a so as to
Anvil block 510 is driven and is contacted at nail bin 512.510 pressable nail bin 512 of anvil block and nail 14 is deployed through destination organization
" T ", as shown in figure 25.Such system may include being configured to closed anvil 510 and firing end for end effector 506
First drive system of the nail 14 in portion's actuator 506.
In addition to above-mentioned, end effector 506 may include be configured to incision tissue T and/or nail bin 512 the
Two drive systems.Referring primarily to Figure 23 and Figure 26, shaftless end effector 506 may include cutting element, such as cutting element
540.Cutting element 540 can in the channel being formed in the second jaw member 508b and/or in nail bin 512 longitudinally portion
Administration.In various examples, cutting element 540 may include through the longitudinal hole or mesopore 570 extended through.Drive shaft 564 can
Mesopore 570 is extended through, and drive shaft 564 can not be operatively engaged with cutting element 540.In various examples, closely
Slide 522a may include driven connector 576 extending therefrom.Driven connector 576 may include limit wherein, can quilt
It is constructed to be permeable to receive the hole 571 of bar 580.Bar 580 can be positioned in driving input unit 578, wherein driving input unit 578 can be attached
It is connected to driven connector 576.Once driving input unit 578 has been assembled to driven connector 576, it will be able to bar 580 be made to advance
Pusher into end effector 506 to engage cutting element 540 and/or to be located between bar 580 and cutting element 540
Component 541.In various examples, bar 580 and/or pusher member 541 can abut cutting element 540 and make cutting element 540
Towards being distally advanced to cut storehouse 512 and/or capture the tissue T between storehouse 512 and anvil block 510.In some instances, bar 580
It can bounce back, and cutting element 540 can stay in its progressive position.In other instances, bar 580 may include distal side attachment part,
The distal side attachment part is configured to engagement cutting element 540, drives cutting element 540 towards distal side, and then will
Cutting element 540 is proximally pulled to such as its non-firing position.In at least one such embodiment, cutting element 540
May include limit wherein, be configured to receive bar 580 attachment part pod.It has been bounced back in cutting element 540
Afterwards, bar 580 can be made to become to separate with cutting element 540 by applying enough power to bar 580.
Such as reader it is understood that the first drive system of end effector 506 be configured to closed anvil 510 and
Percussion nail 14, and the second drive system of end effector 506 is configured to incision capture in end effector 506
Tissue T.First drive system and the second drive system can operate independently of one another.For example, the first drive system can be clinical
Doctor's operation, wherein clinician can decide whether to operate and/or when operate the second drive system.Figure 22,25 and
26 show shaftless end effector 506 converts between open position and firing position.Figure 22 shows in an open position
Shaftless end effector 506.Destination organization " T " is located between anvil block 510 and nail bin 512.By being made with such as grasper
Anvil block 510 moves to make anvil block 510 be pivoted to partial closed position from open position.Driving input unit 568 could attach to axis 564
Driving end 566 and drive input unit 578 that can be attached to driving in any suitable during surgical instruments use to connect
Connect device 576.In some instances, one or both of driving input unit 568 and driving input unit 578 can be in end effectors
506 be located in operative site before be attached to end effector 506.In various examples, driving input unit 568 and driving are defeated
End effector can be attached to after end effector 506 has been located in operative site by entering one or both of portion 578
506.In some instances, driving end 566 can be assembled in driving input unit 568, is not driven input unit 578 and is assembled into driving end
576 influence.In other instances, driving input unit 568 and driving input unit 578 may include actuator, the actuator
Component allows driving input unit 568 and driving input unit 578 to be assembled into end effector 506 simultaneously.When in use, it drives defeated
Enter portion 568 be actuated to rotation rotatable shaft 564 and nearly slide 522a and distal side sliding part 522b held towards end
The central point zigzag tread patterns of row device 506.As discussed above, the cam 530 on nearside sliding part 522a and distal side sliding part 522b
Accessible first jaw 8a is so that anvil block 510 moves to form nail as shown in figure 25 towards nail bin 512.In addition, using
When, driving input unit 578 is activated, to make firing member 540 advance.In some instances, input unit 568 and driving are driven
Input unit 578 can be operated successively.In at least one example, driving input unit 568 can be operated, then operates driving input unit again
578.In some instances, driving input unit 578 can just be operated after the operation of driving input unit 568 has terminated.Extremely
In few such example, in operation driving input unit 578 so that before blade 540 advances, can operate driving input unit 568 with
Nail 14 is set to be fully formed or suitably shape.In various examples, the operation of driving input unit 568 and driving input unit 578 can
At least partly it is overlapped.In at least one such example, driving input unit 568 can be operated, and can be in operation driving input
Operation driving input unit 578 during portion 568.
Figure 27 is shown for the integrated form with the handover of the closed system 620 of shaftless end effector 606 shown in Figure 28
The embodiment of closure and firing lock 680.End effector 606 includes the first jaw member 608a, the second jaw member
608b and frame 694.First jaw member 608a includes anvil block 610.Second jaw member 608b includes being configured to
Wherein receive the vertical passage 642 of nail bin 612.Referring to fig. 28,30 and 32, the first jaw member 608a and the second jaw member
608b is pivotally coupled by pivot pin 615.Referring primarily to Figure 32, pin 615 extends from frame 694, and the first jaw member
608a and the second jaw member 608b is rotationally coupled to frame 694 by pin 615.The pincers of first jaw member 608a and second
Mouth component 608b can pivotally be moved relative to central axis " A ".Shaftless closed system 620 is located at shaftless end effector
At 606 proximal end.Shaftless closed system 620 includes rotatable lining ring 690, which includes being configured to
Rotatably join with the one or more screw threads 696 being formed on the first jaw member 608a and the second jaw member 608b
One or more screw threads 698.In at least one example, screw thread 696 may include around by the first jaw member 608a and second
Continuous group of the screw thread that the periphery that jaw member 608b is limited extends.The rotation of rotatable lining ring 690 in a first direction makes
One jaw member 608a and/or the second jaw member 608b is pivoted towards central axis " A ", as shown in figure 30.Lining ring 690 is
Two or opposite direction on rotation make the first jaw member 608a and/or the second jaw member 608b far from axis " A " pivot, such as
Shown in Figure 30.As described in greater detail below, lining ring 690 may include the interconnecting piece that can be operably attached to driving input unit
Point.End effector 606 may also include cutting element 640, which is configured to incision nail bin 612 and/or catches
Obtain the tissue between storehouse 612 and anvil block 610.Cutting element 640 may include coupling part, such as cutting from cutting element 640
Cut the connecting elements 643 that part 672 extends proximally.As described in greater detail below, connecting elements 643 can be operationally attached
It is connected to driving input unit.In various examples, frame 694 may include longitudinal hole 693 defined therein, wherein connecting elements
643 can slidably be received in hole 693.
Referring primarily to Figure 27, firing lock 680 may include frame 682, rotatable outer driver 686 and translatable interior drive
Dynamic device 688.Referring to fig. 28 to Figure 30, rotatable lining ring 690 may include limit wherein, be configured to receive percussion lock
The opening 695 of the frame 682 of structure 680.In various examples, frame 682 can be closely received in opening 695.In certain realities
Example in, frame 682 may include limit wherein, be configured to receive end effector 604 frame 694 longitudinal hole
681.With it is like above, frame 694 can be closely received in the hole 681 of frame 682.In various examples, frame 694 and frame
Frame 682 can be press-fitted together.In some instances, frame 682 can be press-fitted between frame 694 and lining ring 690.In some examples
In, bayonet connection can be formed between frame 682 and frame 694.In at least one embodiment, frame 694 may include limit
Be scheduled on one or more of bayonet slits 692, the one or more bayonet slit can respectively be configured to receive from
The pillar 699 that frame 682 extends internally.In order to which frame 682 is assembled into frame 694, pillar 699 be can be positioned in slit 692
And bent angle or the elbow reached in slit 692 until these pillars is pushed towards distal side.At such point, rotatable or torsion frame
Frame 682 is so that pillar 699 to be locked in slit 692.It, can be opposite in order to make frame 682 disconnect the connection with frame 694
Rotating frame 682 on direction so that pillar 699 moves to unlocked position so that frame 682 then can proximally be pulled it is separate
Frame 694.
As discussed above, lining ring 690 may include coupling part.In various examples, lining ring 690 may include limiting wherein
One or more driving slits 691, what one or more driving slit was configured to reception firing lock 680 can
Rotate at least part of outer driver 686.In some instances, rotatable outer driver 686 may include that can be positioned on driving
One or more driving tabs 687 in slit 691.In at least one example, lining ring 690 may include being located at lining ring 690
The first driving slit 691 on first side and the second or on opposite sides second driving slit 691 positioned at lining ring 690, and
And therefore, rotatable outer driver 686 may include can be located in the first driving slit 691 first driving tab 687 with
And the second driving tab 687 in the second driving slit 691 can be located in.When in use, driving tab 687 can transport rotation
It is dynamic to be transmitted to rotatable lining ring 690 from rotatable outer driver 686.In various examples, driving tab 687 can closely be connect
It is received in driving slit 691, driving tab 687 is enabled to engage the driving slit 691 that the driving tab is wherein located
Side wall.When in use, outer driver 686 can be rotated in a first direction to rotate lining ring 690 in a first direction and to close
Close end effector 606.As described above, outer driver 686 can be used be closed end effector 606, pressing storehouse 612 and
Make 14 deformation of nail.Any right times during using end effector 606, can rotate outer driver in a second direction
686 lining ring and open end effector 606 to rotate on second or opposite direction.
As discussed above, cutting element 640 may include connecting elements 643.In various examples, connecting elements 643 can be wrapped
Connection slit 644 defined therein is included, which is configured to receive the translatable interior drive of firing lock 680
At least part of dynamic device 688.In certain embodiments, inner driver 688 may include releasably keeping
Driving end 684 in connection slit 644.As shown in Figure 29 and Figure 30, inner driver 688 can be inserted into frame aperture 693 to incite somebody to action
Driving end 684 is connected to cutting element 640.When in use, inner driver 688 can be pushed to cut to push towards distal side towards distal side
Component 640 and crosscutting nail bin 612 and/or the tissue being located between nail bin 612 and anvil block 610.In various examples,
Inner driver 688 can be operated after operating outer driver 686.In at least one such example, nail 14 can make to cut
Component 640 is fully formed before advancing.In some instances, inner driver 688 and outer driver 686 can operate simultaneously.
When in use, it is complete can or can can not to be pivoted to its by rotatable lining ring 690 by jaw 608a and 608b
Full-application position.Such example can typically occur in capture tissue between jaw 608a and 608b it is thicker when.Each
In kind embodiment, cutting element 640 may include one or more gaps setting flanges, such as can promote jaw 608a and 608b
Closure flange 641a and 641b.More specifically, cutting element 640 may include being configured in cutting element 640
Towards the first gap setting flange 641a for engaging the first jaw 608a when being distally advanced.In various examples, the first flange 641a,
Second flange 641b and cut portion may include such as I shape or I-beam configuration.Referring primarily to Figure 31, the first flange 641a can
It is slided in the slit in the top surface for being defined in the first jaw 608a.More specifically, cutting element 640 may include can be by structure
It causes flange 641b can be arranged towards the Second gap for engaging the second jaw 608b when being distally advanced in cutting element 640.Mainly
Referring to Figure 31, the second flange 641b can be slided in the slit in the top surface for being defined in the second jaw 608b.In cutting structure
For part 640 towards when being distally advanced, flange 641a and 641b are controllable or are arranged between the first jaw 608a and the second jaw 608b
Distance.In various examples, the inclined of tissue in end effector 606, nail bin 612, and/or end effector 606 is captured
Pressing spring can be respectively by the outside against flange 641a and 641b of jaw 608a and 608b.In such example, cutting element
640 can make jaw 608a and 608b move to its fully closed position.Some embodiments are contemplated, in these embodiments
In, the advance of cutting element 640 can be enough for example to be closed jaw 608a and 608b, percussion nail 14 and incision tissue T.
Apparatus as disclosed herein be designed to be intended for single use after abandon or they be designed to can be used it is more
It is secondary.However, no matter what kind of situation it is, which all can be at least using exercising use by repairing after primary again.Again repairing can
Any combination in including the following steps: the device is dismantled, then cleans or replaces specific component and then re-assembly.
Specifically, which can dismantle, and it is any amount of specific selectively can be replaced or be removed the device with any combination
Component or part.After cleaning and/or replacement specific component, which can be re-assemblied at repairing mechanism then to make
With, or re-assemblied immediately before surgery by surgical team.It will be understood by those of skill in the art that device
Again repair can utilize it is a variety of be used to dismantle, the technology for cleaning/replace and re-assembly.The purposes of these technologies and resulting
Again prosthetic device is within the scope of the present invention.
Preferably, invention as described herein will be handled before surgery.Firstly, obtaining new or used instrument, and root
According to being cleaned.Then it can sterilize to instrument.In a kind of sterilization technology, which is placed on closure and sealing
Container in, in such as plastics or TYVEK bag.Then container and instrument are placed on to the radiation field such as γ that can penetrate the container
In radiation, x- ray or high energy electron.The bacterium on instrument and in container is killed in radiation.Then the instrument after sterilizing can be stored
In sterile chamber.The sealing container makes instrument keep sterile until opening the container in medical institutions.
Any patent, announcement or other public materials incorporated in this article in full or in part by reference only simultaneously
The material entered is not incorporated herein in existing definition described in the disclosure, statement or the conflicting range of other public materials.Together
Sample and at the necessary level, the disclosure that the application is expressly recited instead of be incorporated herein in a manner of citation appoint
What conflict material.It is said that be herein incorporated by reference but with existing definition as described herein, statement or other public material phases
Any material of conflict or part thereof, under the degree for only not generating conflict between the incorporated material and the existing public material
It is incorporated herein.
It, can also be right in the spirit and scope of the disclosure although the present invention has been described as having illustrative design
The present invention modifies.Therefore this application is intended to cover any modification, purposes or the modified versions using general principles.
In addition, this application is intended to cover belong to known or used this different from the disclosure having in practical framework in fields of the present invention
Class pattern.
Claims (17)
1. a kind of shaftless end effector, comprising:
Anvil assembly, the anvil assembly include:
First jaw member comprising anvil block;With
Second jaw member is the form of anvil block frame, and the anvil block frame includes being configured to receive nail wherein
The staple cartridge channel in storehouse;With
Wherein the anvil block includes:
Nearside hub switch side, the nearside hub switch side are rotationally coupled to the anvil block frame;
Movable distal end portion;With
Staple forming surface;
It is characterized in that, the shaftless end effector further include:
Closed system, the closed system are configured to engage the distal end portion of the anvil block;And
Drive system, the drive system include input unit connector, wherein the drive system is configured to operation institute
It states closed system and the anvil block is transformed into closed position from open position, and be wherein inserted into the end effector
To after treatment site, actuator can be connected to the drive system.
2. shaftless end effector according to claim 1, wherein the closed system includes proximal end sliding part, institute
It states proximal end sliding part to be configured to slidably join with the proximal end of the anvil block frame, by institute
It states anvil block and is transformed into the closed position from the open position.
3. shaftless end effector according to claim 2, wherein the closed system includes distal end sliding part, institute
It states distal end sliding part to be configured to slidably join with the distal end of the anvil block frame, by institute
It states anvil block and is transformed into the closed position from the open position.
4. shaftless end effector according to claim 3, further includes:
It is slidably connected to the proximal shaft of the proximal end of the anvil block frame, wherein the proximal end is sliding
Moving part is connected to the proximal shaft;
It is slidably connected to the distal shaft of the distal end of the anvil block frame, wherein the distal end is sliding
Moving part is connected to the distal shaft, and wherein the closed system is configured to make the proximal end sliding part and institute
It states distal end sliding part to slide towards each other, the anvil block is transformed into the closed position from the open position.
5. shaftless end effector according to claim 4, wherein the proximal end sliding part and the distal end
Sliding part is configured to join with grasper, and wherein the actuator includes grasper.
It further include being connected to the proximal end sliding part and described 6. shaftless end effector according to claim 3
The rotatable shaft of distal end sliding part, wherein the rotation of the rotatable shaft in a first direction slides the proximal end
Part and the distal end sliding part towards the anvil block frame center movement, and wherein the rotatable shaft opposite
Rotation on direction make the proximal end sliding part and the distal end sliding part far from the anvil block frame it is described in
Heart movement.
7. shaftless end effector according to claim 1, further includes cutting device, wherein the cutting device is constructed
At the tissue that can be cut when the anvil block is transformed into the closed position between the anvil block and the staple cartridge channel
Segment.
8. shaftless end effector according to claim 1, further includes:
Rotatable shaft in the anvil block frame;
The cutting device being operatively engaged with the rotatable shaft, wherein the rotation of the rotatable shaft is configured to make
The cutting device moves between the nearside hub switch side of the anvil block and the distal end portion.
9. shaftless end effector according to claim 1 further includes corresponding multiple with multiple height of the anvil block
Recess, wherein the multiple recess is configured to provide the present level to the anvil block relative to the anvil block frame
Instruction.
10. shaftless end effector according to claim 1, in which:
The anvil block frame includes first end and second end;
Wherein the anvil block is connected to the anvil block frame between the open position and the closed position;
Wherein the anvil block frame further includes nail bin, and the nail bin includes:
Warehouse including multiple nail cavities;With
The multiple nails being removably positioned in the nail cavity;
Wherein the closed system include can relative to first end motion the first cam and can be relative to described the
Second cam of two end motions, wherein movement and second cam of first cam relative to the first end are opposite
The anvil block is converted between the open position and the closed position in the movement of the second end.
11. shaftless end effector according to claim 10, wherein the anvil block includes the first inclined-plane and the second inclined-plane,
Wherein first cam includes the first ramp, wherein second cam includes the second ramp, and wherein first slope
Road is configured to join with first inclined-plane, and second ramp is configured to join with second inclined-plane
To be closed the anvil block in parallel motion.
12. shaftless end effector according to claim 11 further includes being revolved by what the frame was pivotably supported
Shaft, wherein the rotatable shaft is operatively engaged with first cam and second cam, and it is wherein described can
The rotation of rotary shaft causes first cam and second cam to move towards each other and beat the anvil block described
It is converted between open position and the closed position.
13. shaftless end effector according to claim 12 further includes the cutting device for being connected to the rotatable shaft,
Wherein the rotation of the rotatable shaft makes the cutting device advance from the first end of the frame towards the second end.
14. shaftless end effector according to claim 10, wherein first cam includes the first promotion surface,
Described in the second cam include second push surface, and wherein it is described first push surface and it is described second push surface by structure
It causes to join with grasper.
15. shaftless end effector according to claim 10, further includes cutting device, wherein the cutting device is by structure
It causes that the tissue section between the anvil block and the staple cartridge channel can be cut when the anvil block is transformed into closed position
Section.
16. shaftless end effector according to claim 10, further includes cutting device, wherein the cutting device is by structure
It causes that the tissue between the anvil block and the staple cartridge channel can be cut after the anvil block is transformed into closed position
Segment.
17. shaftless end effector according to claim 10, wherein first cam and second cam are respectively
Including adjustable closure member, wherein each adjustable closure member include be configured to indicate the anvil block closing capacity it is more
A calibration dent, and wherein first cam and second cam can be moved independently to adjust the closing capacity.
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
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US14/178,840 | 2014-02-12 | ||
US14/178,840 US9962161B2 (en) | 2014-02-12 | 2014-02-12 | Deliverable surgical instrument |
PCT/US2015/012165 WO2015122998A1 (en) | 2014-02-12 | 2015-01-21 | Deliverable surgical instrument |
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Publication Number | Publication Date |
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CN106061406A CN106061406A (en) | 2016-10-26 |
CN106061406B true CN106061406B (en) | 2019-08-16 |
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CN201580008291.1A Active CN106061406B (en) | 2014-02-12 | 2015-01-21 | It can delivery type surgical instruments |
Country Status (6)
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US (2) | US9962161B2 (en) |
EP (2) | EP2907455B1 (en) |
JP (1) | JP6472811B2 (en) |
CN (1) | CN106061406B (en) |
BR (1) | BR112016018567B1 (en) |
WO (1) | WO2015122998A1 (en) |
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